Vectorborne Diseases in Maine

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Melvin Kelley
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1 Vectorborne Diseases in Maine Presented by: Maine Center for Disease Control and Prevention Emer Smith, MPH Field Epidemiologist

2 Presentation Agenda Tick biology Lyme disease Other tick-borne diseases in Maine Prevention Mosquito ecology Mosquito-borne illnesses

3 Ticks in Maine There are 15 different species of ticks endemic to Maine Deer Ticks, Dog Ticks, Woodchuck tick, squirrel tick, Ixodes muris, Ixodes angustus, Moose tick, Rabbit tick, Lone Star Tick, Brown Dog Tick (Kennel Tick), Bird Tick, Ixodes brunneus, Ixodes dentatus, Ixodes uriae, and Ixodes banksi.

disease Nymphal ticks (~1/16 ): most commonly bite humans and are usually found in

4 Ixodes Scapularis (Deer Tick) Blacklegged (or deer) ticks (Ixodes scapularis can transmit several tickborne diseases including anaplasmosis, babesiosis, and Lyme disease Nymphal ticks (~1/16 ): most commonly bite humans and are usually found in the spring and fall Generally, deer ticks prefer wooded areas. Larger than actual size.

5 Dermacentor Variabilis (Dog Tick) Dog ticks (Dermacentor variabilis) have either a white scutum (dot or shield behind the head) or white racing stripes down the back In the summer, large adult dog ticks (1/8-3/16 ) can be found. Typically they are commonly found in open habitats

6 Deer Ticks vs. Dog Ticks Deer Ticks Dog Ticks

9 Bite is Worse Than the Bark Hypostome barbed Ticks secrete an anesthesia and anticoagulant when biting To transmit the Lyme bacterium (Borrelia burgdorferi), ticks must feed for at least 24 hours! A B A: Scanning Electron Microcope (SEM) image of a deer tick. Courtesy of MicroAngela B: Borrelia burgdorferi spirochete. Courtesy of US CDC

10 Tick Distribution

11 Weekly Deer Tick Submissions:

12 Ticks & Habitat Favorable Habitat Deciduous (broadleaf) forest such as oaks Shrubby areas Photos: MMCRI

13 Unfavorable Habitat Open, dry habitats

14 Lyme Disease

Symptoms of Lyme Disease Early Manifestations of Lyme Disease Erythema migrans (bull s eye rash) Muscle and joint pain Fatigue Chills, fever, and headache Swollen lymph nodes Disseminated

15 Symptoms of Lyme Disease Early Manifestations of Lyme Disease Erythema migrans (bull s eye rash) Muscle and joint pain Fatigue Chills, fever, and headache Swollen lymph nodes Disseminated Manifestations of Lyme Disease Arthritis with recurrent, brief attacks of joint swelling Lymphocytic meningitis Cranial neuritis (such as Bell s palsy) Encephalitis 2 nd or 3 rd degree atrioventricular block EM image: CDC

17 Number of Cases Lyme Disease Cases Maine, Lyme Disease Cases - Maine,

18 Lyme Disease in Maine

19 Number of Cases Seasonality of Cases in Maine Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec *data as of 1/18/2017

20 Rate per 100,000 persons Lyme Disease Rates by Age Group Maine, Lyme disease rates by age group: Maine * <

21 Percentage Lyme Disease Symptoms Maine * EM Arthritis Neurologic Cardiac *data as of 1/18/2017

22 Treatment Identify symptoms early, as treatment is more effective the earlier it is started If bitten by a deer tick: monitor for signs and symptoms of Lyme disease for 3-30 days following bite If you have symptoms consistent with Lyme Disease, consult a healthcare provider for treatment Current treatment guidelines can be found on the Infectious Diseases Society of America website:

23 Other Tick-borne diseases

24 Anaplasmosis Carried by Ixodes scapularis tick Symptoms range from mild: (fever, headaches, body aches) to severe: (encephalitis, death). Testing can be done by PCR (preferred), morulae visualization, or serology

Anaplasmosis Cases 2016: 372 2015: 185 2014: 191 2013: 94 2012: 52

25 Anaplasmosis Cases 2016: : : : : : : : : : 9 Anaplasmosis cases - Maine, 2015

26 Babesiosis Carried by Ixodes scapularis tick Symptoms include: fatigue, sweating, dark urine, chills and possible anemia. Testing can be done by PCR (preferred), parasite visualization, or serology

27 Babesiosis Cases 2016: : : : : : : : : : 11 Babesiosis cases - Maine, 2015

28 Powassan Maine had confirmed cases in 2013, 2015, 2016, and 2017 Rare Two strains of the virus, one carries by Ixodes scapularis (DTV) and one carried by Ixodes cookei. Clinically there is no difference between the strains Only tickborne arboviral disease in the U.S. and Canada

29 Powassan This is the link to the PubMed abstract for the article that is most commonly cited for the 15 minute transmission time for Powassan

30 Other Tick-Borne diseases Rocky Mountain Spotted Fever (RMSF) Potentially carried by the dog tick (Dermacenter variabilis) Ticks in Maine not known to be infected Symptoms include fever, headache, rash Testing is by serology Ehrlichiosis Carried by the Lonestar tick (Amblyomma americanum) which is uncommon in Maine Symptoms include fever, headache, nausea and body aches Testing by PCR (preferred) or serology

31 Borrelia miyamotoi Newly described tick-borne illness Closely related to bacteria that cause tick-borne relapsing fever First identified in ticks in 1995 First cases identified in Maine residents in 2016 Commercial tests available from multiple reference laboratories (Imugen, Mayo, Quest)

33 Personal Protection Dress appropriately when outdoors Use repellants containing DEET, oil of lemon eucalyptus, IR3535, picaridin, or permethrin Thoroughly wash and dry clothes

34 Personal Protection Do a daily Tick Check by sight and by touchinspect your body after being outdoors, and again a few hours later Pay attention to your head, hairline, nape of the neck, armpits, waist, between your legs, thighs, and behind the knees Do a Tick Check on your pets as well

35 Personal Protection: Tick Check

Remove plants that attract deer and construct physical

36 Make your yard safer Remove brush, leaf litter and tall grass Create a dry border between woods and lawn Before Remove plants that attract deer and construct physical barriers that may discourage deer from entering your yard After

37 Tick Removal: Prompt Removal is Important! With a Tick Spoon Place the wide part of the notch on the skin near the tick (hold skin taut if necessary) Applying slight pressure downward on the skin, slide the spoon forward so the small part of the notch is framing the tick Continuous sliding motion of the remover detaches the tick With Tweezers Grasp the tick close to the skin with tweezers Pull gently until the tick lets go

38 Killing / Preserving Ticks To kill a tick found in your home or removed from a person or pet, it is easiest to put it in a container of rubbing alcohol Tick will soon die and be preserved in the event it is submitted to a laboratory Washing your clothes will not kill the tick, however drying the clothes on high heat before washing will kill the ticks.

39 Submitting Ticks Tick identification is available at the University of Maine Orono Cooperative Extension Tick submission form should accompany each tick. Forms and instructions can be downloaded at

40 Submitting Ticks Contact physician for medical advice Send ticks in crushproof, waterproof container in rubbing alcohol. Tick species and degree of engorgement will be identified Ticks will not be tested to see if they carry Lyme

42 Mosquito Borne Diseases

infected will have no obvious symptoms West Nile virus Occurs

43 Mosquito-borne diseases Eastern Equine Encephalitis One of the most serious mosquito-borne diseases in the United States Many persons infected will have no obvious symptoms West Nile virus Occurs throughout the United States Many persons infected will have no obvious symptoms

44 Mosquito Species 45 mosquito species in Maine, however less than half are considered to be likely vectors for EEE and WNV

45 EEE vector habitat Photo courtesy of Kim Foss, Swamp Inc Cs. melanura primary vector of EEE Bogs and swamps Mature hemlock, immature red maple, yellow birch, beech, winterberry, shrubs Clear or tea colored water Peat bottom Acidic Early emergence in spring, overwinter as larvae, multiple generations Also WNV competent Primarily bird biters

46 WNV vector habitat Cx. pipiens/restuans common WNV vector Artificial containers Catch basins Flower pots Discarded tires Stagnant temporary pools Holes in trees Multiple generations Can overwinter as adults Generalist feeders

47 EEEV and WNV Transmission Cycle Bridge mosquito vectors Amplification cycle Incidental & dead-end hosts

48 Symptoms of Arboviral Illness MOST people infected with an arbovirus will not have symptoms Symptoms can be very mild to very severe and appear 3-18 days after infection Mild Fever Head and body aches Lack of energy Neuroinvasive Disease Central nervous system involvement Stiff neck, altered mental status, inflammation of the brain, respiratory distress, paralysis, coma, death Symptoms usually last 1-2 weeks, no treatment, only support

49 # of cases Arboviruses in Maine, EEE mosquitoes EEE horse EEE pheasants EEE llama EEE emu WNV mosquitoes WNV human EEE human

For More Information Maine CDC disease reporting and consultation line: 1-800-821-5821 Maine Medical Center Research Institute Vector-borne Disease Lab: 207-396-8246 ticklab@mmc.

51 For More Information Maine CDC disease reporting and consultation line: Maine Medical Center Research Institute Vector-borne Disease Lab: UMaine Cooperative Extension: Maine CDC Vector-Borne Disease Website:

53 Thank You! Emer S. Smith, MPH Field Epidemiologist, Cumberland District (207)

REPORT TO THE BOARDS OF HEALTH Jennifer Morse, M.D., Medical Director

Ticks and Tick-borne illness REPORT TO THE BOARDS OF HEALTH Jennifer Morse, M.D., Medical Director District Health Department #10, Friday, May 19, 2017 Mid-Michigan District Health Department, Wednesday,